Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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Webster

Books have been written about the 1997 outbreak. Noted journalist Pete Davies was with Webster eight months after the mass slaughter, perched on an Arctic mountainside within miles of the North Pole. He asked Webster if they had done the right thing killing all those chickens in Hong Kong. “It was a killer—like 1918 on its way,” Webster replied.294 If the chickens hadn’t been killed, “I would predict that you and I would not be sitting here talking now. Because one of us would be dead.”295

Other experts agree. “Imagine if that virus obtained a little additional capacity to be freely transmitted in humans,” said Klaus Stöhr, head of the World Health Organization’s influenza program, “a large proportion of the population of the world would presumably have died.”296 Fukuda explains: “When you look at the people who died…[most] were basically healthy young adults. These are not the kinds of people you normally see dying from influenza…and most of them died from illnesses generally consistent with viral pneumonia—so it’s very similar to the picture we saw in 1918. It’s disturbingly similar—and that’s what gave this added sick feeling in all our stomachs.”297

The Hong Kong government took heat from the poultry industry for its decision to kill more than a million birds, but was vindicated by a 1998 joint proclamation signed by 19 of the world’s experts on influenza, including the World Health Organization’s chief authority, expressing gratitude for Hong Kong’s decision. The proclamation concluded: “We may owe our very lives to their actions.”298

Only years later did intensive research on the H5N1 virus reveal how close the world had truly come to facing a pandemic. There was evidence that during the Hong Kong crisis the virus was rapidly adapting to the new human host, acquiring mutations that increased its ability to replicate in human tissue. The University of Hong Kong’s Kennedy Shortridge wrote in 2000, “It is probably fair to say that a pandemic had been averted.”299

The Hong Kong Medical Association’s infectious disease expert, however, warned that this may not have been the end to H5N1. “And as long as we have the circumstances which can favour the spread of H5N1,” he said, “it can occur again.”300 The CDC’s Keiji Fukuda was asked in an interview whether the prospect of H5N1’s return robbed him of any sleep. “More nights than I like,” he admitted.301

Closely studying the Hong Kong H5N1 virus, Webster estimated that it may have taken only months for it “to acquire whatever mutations are needed for transmitting between people—but it would have done it,” he said. “And if it had got away, my God…. I am convinced that this virus was probably like 1918. It was wholly avian, yes—but it had human aspects that we’ve never seen before.”302 Now we suspect the 1918 virus was wholly avian as well, a “human adapted variant of a pathogenic avian strain.”303

Mike Ryan, coordinator of the Global Outbreak Alert and Response Network at the World Health Organization, describes H5N1 in birds as “a disease of biblical proportion.”304 Webster thought about the horrific deaths of the children of Hong Kong. “How many people have immunity to H5?” Webster asked rhetorically. “Zippo.”305 “The chicken population in Pennsylvania [in 1983] is like the world as it is in this moment,” Webster said. “There are millions of us ‘chickens’ just waiting to be infected.”306

In a textbook published by Oxford University, Webster wrote this about the Pennsylvania H5 outbreak in 1983:
How do we cope with such an epidemic? The Agriculture Department used the standard methods of eradication, killing the infected chickens and exposed neighboring birds and burying the carcasses. But we can’t help asking ourselves what we would have done if this virus had occurred in humans. We can’t dig holes and bury all the people in the world.307